不同Calot三角解剖入路腹腔镜胆囊切除术治疗胆囊结石合并慢性胆囊炎的临床疗效

Application of different anatomical approaches of Calot triangle in laparoscopic cholecystectomy

目的观察不同Calot三角解剖入路腹腔镜胆囊切除术治疗胆囊结石合并慢性胆囊炎的临床疗效。方法采用回顾性分析方法,以2019年1月至2020年6月淮南市东方医院集团总院收治入院的82例胆囊结石合并慢性胆囊炎患者为研究对象,均行腹腔镜胆囊切除术治疗,根据不同入路方式分为研究组(41例)与对照组(41例),研究组选用胆囊后三角解剖入路,对照组选用胆囊三角入路。比较2组患者手术前后血清细胞因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、白细胞介素-6(IL-6)和C-反应蛋白(CRP)]水平、手术相关指标(术中出血量、手术时间、肠功能恢复时间、住院时间、中转开腹发生率)及并发症发生率。结果术前,2组患者血清细胞因子水平比较,差异均无统计学意义(P>0.05);术后,研究组患者血清TNF-α、IL-8、IL-6和CRP水平分别为(19.24±4.58) ng/L、(18.43±5.36) ng/L、(20.24±7.45) ng/L、(12.05±2.16) mg/L,均低于对照组[(19.24±4.58) ng/L、(18.43±5.36)ng/L、(20.24±7.45) ng/L、(12.05±2.16) mg/L],差异均有统计学意义(P<0.05)。研究组患者中转开腹、并发症发生率、术中出血量为2.44%、2.44%、(32.52±3.27) mL,均低于对照组[19.51%、21.95%、(50.71±4.73) mL],手术时间、肠功能恢复时间、住院时间分别为(29.36±4.28) min、(25.91±4.14) h、(5.97±1.05) d,短于对照组[(58.93±5.41) min、(30.27±4.46) h、(8.32±1.13) d],差异均有统计学意义(P<0.05)。结论治疗胆囊结石合并慢性胆囊炎,腹腔镜胆囊切除术中胆囊后三角解剖入路的临床疗效明显优于胆囊三角入路,术后血清细胞因子水平明显低于胆囊三角入路,可减少患者出血量及并发症,降低中转开腹率,且对患者机体刺激更小,有利于术后快速康复。

Objective To observe the clinical efficacy of different Calot triangular anatomical approaches for laparoscopic cholecystectomy in the treatment of gallbladder stones with chronic cholecystitis. Methods Retrospective analysis was performed on 82 patients with cholecystolithiasis complicated with chronic cholecystitis who were admitted to Huainan Dongfang Hospital Group from January 2019 to June 2020. All of them received LC treatment,and were divided into study group(41 cases) and control group(41 cases) according to different approaches. The posterior gallbladder triangle anatomical approach was used in the study group and the gallbladder triangle approach was used in the control group. The changes of serum cytokine[tumor necrosis factor α(TNF-α),interleukin-8(IL-8),interleukin-6(IL-6),C-reactive protein(CRP) ]levels before and after surgery,the operation-related indicators(intraoperative blood loss,operation time,recovery time of intestinal function,hospital stay,incidence of conversion to laparotomy) and the incidence of complications were compared between the two groups. Results There was no significant difference in serum cytokine levels between the two groups before operation(P>0.05). After the operation,the levels of serum TNF-α,IL-8,IL-6 and CRP in the study group were(19. 24 ± 4. 58) ng/L,(18. 43 ± 5. 36) ng/L,(20. 24 ± 7. 45) ng/L,(12. 05 ±2. 16) mg/L,which were lower than those in the control group [(19. 24 ± 4. 58) ng/L,(18. 43 ± 5. 36) ng/L,(20. 24 ± 7. 45) ng/L,(12. 05± 2. 16) mg/L],the differences were statistically significant(P<0.05). The patients in the study group converted to laparotomy,the incidence of complications,and intraoperative blood loss were 2. 44%,2. 44%,and(32. 52 ± 3. 27) mL,which were lower than those in the control group[19. 51%,21. 95%,(50. 71 ±4. 73) mL],operation time,bowel function recovery time,and hospital stay were(29. 36 ±4. 28) min,(25. 91 ±4. 14) h,(5. 97 ± 1. 05) d,which were shorter than those in the control group [(58. 93 ± 5. 41) min,(30. 27 ± 4. 46) h,(8. 32 ± 1. 13) d],the differences were statistically significant(P<0.05). Conclusion In the treatment of gallbladder stones and chronic cholecystitis,the clinical effect of the posterior triangle of the gallbladder during laparoscopic cholecystectomy is significantly better than that of the triangle of gallbladder,and the postoperative serum cytokine levels are significantly lower than those of the triangle of gallbladder,which can reduce the amount of bleeding And complications,reduce the conversion rate of laparotomy,and have less stimulation to the patient’s body,which is conducive to rapid postoperative recovery.